Public Health Alert: High Return on Investment

In a recent article written in The Nation’s Health, the American Public Health Association’s (APHA’s) newspaper, public health experts give reason to increase efforts in prevention and education as a better alternative to decreasing health care spending over simply investing in the treatment/medical sector. Titled “Bolstering public health investment can improve U.S. health,” the article advocates for doubling public health funding, from $11.6 bil to $24 bil per year, as a starting point, to meet needs of public health departments. As Dr. Marthe Gold, MD MPH mentioned: “Until we can turn off the flow of Americans who need to enter the medical system by changing social and physical environmental conditions that make them unhealthy, we are just going to keep putting more and more pressure on an expensive system and create needless suffering for people.”

The push to double PH funding comes from the “For the Public’s Health: Investing in a Healthier Future” report, the third in a series examining strengthening the nation’s public health system, that recommends pulling the extra ~$12 bil via a “transaction tax” placed on medical care services. The funds raised would be used to improve environmental and social conditions to promote health and prevent disease.

While the idea of doubling public health funding is something I can stand by, and I fully agree that doubling should be simply a starting point ($24 bil in a $2.5 trilion spending is a dime in a well), the suggestion to place a transaction tax on medical services does not sit well with me. In a system that already has major dysfunctions in payment and delivery, with spending trends quickly running out of control, inserting an additional layer of spending, regardless of how small, is an added burden on practices and patients alike. As a consumer of health services on a student health plan (read “high co-payments on everything but routine appointments”), this “transaction tax” could very likely end up in my medical bill at the end of the day. And while I’m an avid supporter of prevention and education, and I would probably have no quarrels paying the tax, many others may not.

Instead of looking at taxing the heath care system to raise funds, why not tax fast food purchases? With such a strong commitment to decrease obesity-related illness, placing taxes on purchasing fast food items might be an alternative. Of course there are always multiple sides to the story, and many would argue that families living in poverty rely on fast food as a cheap way to survive. Even in today’s society, public health is not an obvious investment strategy, with public opinion on public health proving it. Because of the lack of widespread knowledge and understanding of what public health is, taxation remains one of few options to generate public health funds.

Yet public health investments have proven time and again to provide great returns on investment. In a policy brief published by the Robert Wood Johnson Foundation, hard numbers align with the idea of turning off the flow of Americans entering the medical system. For every 10% increase in local public health spending, there was a significant decrease in infant deaths (6.9%), deaths from cardiovascular disease (3.2%), diabetes (1.4%), and cancer (1.1%). A report released by Trust for America’s Health shows that a $10 investment per person in strategic disease prevention programs could lead to a 5-to-1 ROI (that’s CALIFORNIA numbers), with close to $2 bil annual savings.

The mission is clear, and with good supporting evidence. With better funding and a standardized method for financing programs across funding organizations, a safer, healthier America is on the horizon. However, with budget cuts within almost every government department, a doubling of public health funds might be a stretch at the very least.